Provider Demographics
NPI:1184320079
Name:ROYAL-JACKSON, JAMIA
Entity type:Individual
Prefix:MRS
First Name:JAMIA
Middle Name:
Last Name:ROYAL-JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 744
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-0744
Mailing Address - Country:US
Mailing Address - Phone:804-475-8920
Mailing Address - Fax:
Practice Address - Street 1:9201 ARBORETUM PKWY STE 150
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-5403
Practice Address - Country:US
Practice Address - Phone:804-322-7188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014973101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor